Post-operative complications after prolapse surgery — resuscitation and counselling station

Resuscitation and complication-management station: post-operative ureteric injury/obstruction and voiding dysfunction after uterosacral suspension. Tests recognition of the procedure-specific complication, investigation sequencing (renal tract imaging, creatinine, cystoscopy), escalation, and counselling. Includes assessor key and marking domains.

Prompt

You are the urogynaecology registrar on call. A 58-year-old woman is readmitted on day 4 after a vaginal hysterectomy with uterosacral ligament suspension and anterior repair for Stage III prolapse. She has flank pain, a fever of 38.6 degrees Celsius, and oliguria. Her bladder scan after removing the catheter shows a rising post-void residual, and the ward calls you because her creatinine has risen from 70 to 140 micromoles per litre. You have the consultant on the end of the phone.

Station brief

Format. Resuscitation and complication-management station, approximately 12 minutes. You are the on-call urogynaecology registrar; the consultant is on the phone and can come in. The assessor will feed you examination findings and results. ^[5]

Candidate instruction. Assess and manage this post-operative patient, verbalise your differential and escalation, sequence your investigations, and counsel her once stable. ^[5]^[6]

References5Show

[5]Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial JAMA, 2014.PMID 24618964
[6]Jelovsek JE, Barber MD, Brubaker L, et al. Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial JAMA, 2018.PMID 29677302
[8]Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review Obstet Gynecol, 2004.PMID 15458906
[15]Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C Transvaginal mesh or grafts or native tissue repair for vaginal prolapse Cochrane Database Syst Rev, 2024.PMID 38477494
[19]Unger CA, Walters MD, Ridgeway B, Jelovsek JE, Barber MD, Paraiso MF Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse Am J Obstet Gynecol, 2015.PMID 25434838

Post-operative complications after prolapse surgery — resuscitation and counselling station

Station brief

Candidate instruction. Assess and manage this post-operative patient, verbalise your differential and escalation, sequence your investigations, and counsel her once stable. ^[5]^[6]

References5Show

[5]Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial JAMA, 2014.PMID 24618964
[6]Jelovsek JE, Barber MD, Brubaker L, et al. Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial JAMA, 2018.PMID 29677302
[8]Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review Obstet Gynecol, 2004.PMID 15458906
[15]Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C Transvaginal mesh or grafts or native tissue repair for vaginal prolapse Cochrane Database Syst Rev, 2024.PMID 38477494
[19]Unger CA, Walters MD, Ridgeway B, Jelovsek JE, Barber MD, Paraiso MF Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse Am J Obstet Gynecol, 2015.PMID 25434838